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Effect of radioactive iodine therapy on salivary flow rates and oral Streptococcus mutans prevalence in patients with thyroid cancer.

Unstimulated and stimulated salivary flow rates, Streptococcus mutans samples, and dental caries data were obtained from 50 patients with thyroid cancer who had received radioactive iodine, I131, from 0.3 to 20 years earlier. The salivary flow rates were compared with a healthy control group, and the S. mutans counts were compared to a group of patients with head and neck cancer who were sampled before radiotherapy. Flow rates were found to be significantly lower in the patients with thyroid cancer, and S. mutans levels were slightly but not significantly higher than the controls. Longitudinal flow rate data taken on four patients, who served as their own controls before and after I131 therapy, indicated a trend in saliva reduction.

Adult↗

[Effect of radioactive iodine therapy and surgical treatment of thyrotoxicosis on the blood level of thyrotropin].

The radioimmunological method was applied to the study of the thyrotropic hormone (TTH) content in the blood of 308 patients with thyrotoxicosis at various stages of therapy with radioactive iodine and surgical treatment. After 131I treatment and elimination of the thyrotoxicosis symptoms TTH rose 1 to 2 years and 5 to 10 years after the onset of remission, this being regarded as an adaptive response to the changing thyroid activity. The hypothalamo-hypophysio-thyroid interaction was restored after the successful 131I therapy. However, surgical treatment of thyrothoxicosis did not lead to restoration of such interaction for 5 years--no changes of the TTH level followed either the "primary" subtotal thyroidectomy or repeated operation for the relapsing form of the disease.

Follow-Up Studies↗

Hepatocellular carcinoma with skeletal metastasis: management with intraarterial radioactive iodine.

Two patients with skeletal metastasis from hepatocellular carcinoma (HCC) treated with internal radiation are presented. An oily contrast medium injected into the hepatic artery accumulates in the hepatic tumor tissue and remains there for long periods: therefore, an oily contrast tagged with radioactive iodine could intensify therapeutic effect on tumors. I-131 was tagged onto Lipiodol, an iodized oil, and injected into the arteries supplying the tumors of skeletal metastasis and hepatocellular carcinoma delivering high internal radiation to both primary and secondary lesions. At 6-month follow-up period, tumor has decreased in size and patients are alive and pain free.

Adult↗

[Radioactive iodine therapy in Graves' hyperthyroidism].

Graves' disease is the most frequent cause of hyperthyroidism. Clinical thyrotoxicosis is directly caused by autoantibodies that activate the TSH receptor. The etiology is multifactorial, with genetic and nongenetic factors involved. Current treatment options are antithyroid drugs (ATD), radioiodine (131I) and surgery. Radioactive iodine is increasingly being used as definitive therapy, because it long has proven to be a safe, nonexpensive and effective treatment. Recent publications have discussed the use of 131I associated with ATD as well as the identification of predictors of treatment failure, which are discussed in this review. Antithyroid drugs are still the first choice therapy in patients with mild disease, small goiters, children, adolescents, and in pregnancy. Surgery is now rarely performed. It is indicated only in cases where ATD have not been effective and radioiodine is contraindicated or not acceptable by the patients.

Graves Disease↗

Mortality after the treatment of hyperthyroidism with radioactive iodine.

BACKGROUND: Hyperthyroidism affects many organ systems, but the effects are usually considered reversible. The long-term effects of hyperthyroidism on mortality are not known. METHODS: We conducted a population-based study of mortality in a cohort of 7209 subjects with hyperthyroidism who were treated with radioactive iodine in Birmingham, United Kingdom, between 1950 and 1989. The vital status of the subjects was determined on March 1, 1996, and causes of death were ascertained for those who had died. The data on the causes of death were compared with data on age-specific mortality in England and Wales. The standardized mortality ratio was used as a measure of relative risk, and the effect of covariates on mortality was assessed by regression analysis. RESULTS: During 105,028 person-years of follow-up, 3611 subjects died; the expected number of deaths was 3186 (standardized mortality ratio, 1.1; 95 percent confidence interval, 1.1 to 1.2; P<0.001). The risk was increased for deaths due to thyroid disease (106 excess deaths; standardized mortality ratio, 24.8; 95 percent confidence interval, 20.4 to 29.9), cardiovascular disease (240 excess deaths; standardized mortality ratio, 1.2; 95 percent confidence interval, 1.2 to 1.3), and cerebrovascular disease (159 excess deaths; standardized mortality ratio, 1.4; 95 percent confidence interval, 1.2 to 1.5), as well as fracture of the femur (26 excess deaths; standardized mortality ratio, 2.9; 95 percent confidence interval, 2.0 to 3.9). The excess mortality was most evident in the first year after radioiodine therapy and declined thereafter. CONCLUSIONS: Among patients with hyperthyroidism treated with radioiodine, mortality from all causes and mortality due to cardiovascular and cerebrovascular disease and fracture are increased.

Cardiovascular Diseases↗

Gonadal damage due to radioactive iodine (I131) treatment for thyroid carcinoma.

Papillary carcinoma of the thyroid is the most common type of thyroid cancer and is associated with a good prognosis. Complications of treatment with surgery and radioiodine are uncommon. We report the case of a 13 year old boy who developed testicular damage following treatment with radioactive iodine 350 mCi for a papillary carcinoma of the thyroid. Four years after radioiodine treatment there has been no suggestion of recovery of spermatogenesis. Detailed follow-up studies of similarly treated young patients are required to define the incidence of this complication and to determine its reversibility.

Adolescent↗

Temporary ovarian failure in thyroid cancer patients after thyroid remnant ablation with radioactive iodine.

We studied ovarian function retrospectively in 66 women who had regular menstrual cycles before undergoing complete thyroidectomy for differentiated thyroid cancer and subsequent thyroid remnant ablation with 131I. Eighteen women developed temporary amenorrhea accompanied by increased serum gonadotropin concentrations during the first year after 131I therapy. No correlation was found between the radioactive iodine dose absorbed, thyroid uptake before treatment, oral contraceptive use, or thyroid autoimmunity. Only age was a determining factor, with the older women being the most affected. We conclude that radioiodine ablation therapy is followed by transient ovarian failure, especially in older women.

Adult↗

Does thyroidectomy, radioactive iodine therapy, or antithyroid drug treatment alter reactivity of patients' T cells to epitopes of thyrotropin receptor in autoimmune thyroid diseases?

The effect of treatment on thyroid antibody production and T cell reactivity to thyroid antigens was studied in 15 patients with Graves' disease (GD) before and after thyroidectomy, 19 patients with GD before and after radioactive iodine (RAI) therapy, and 9 patients maintained euthyroid on antithyroid drugs (ATD). Twenty subjects matched for age and sex without known thyroid disease served as controls. In GD patients, the responses of peripheral blood mononuclear cells (PBMC) and TSH receptor (TSHR)-specific T cell lines to recombinant human TSHR extracellular domain, thyroglobulin, and TSHR peptides were examined on the day of surgery or RAI therapy (day 0) and also 6-8 weeks and 3-6 months thereafter. Reactivity to TSHR peptides before surgery was heterogeneous and spanned the entire extracellular domain. Six to 8 weeks after subtotal thyroidectomy, the number of patients' PBMC responding to any peptide and the average number of recognized peptides decreased. A further decrease in the T cell reactivity to TSHR peptides was observed 3-6 months after surgery. The responses of PBMC from Graves' patients before RAI therapy were less than those in the presurgical group. Six to 8 weeks after RAI therapy, the number of patients responding to any peptide and the average number of recognized peptides increased. Three to 6 months after RAI, T cell responses to TSHR peptides were less than those 6-8 weeks after RAI therapy, but still higher than the values on day 0. Responses of PBMC from patients with GD, maintained euthyroid on ATD, were lower than those before surgery or RAI therapy. The reactivity of T cell lines in different groups reflected a pattern similar to PBMC after treatment. TSHR antibody and microsomal antibody levels decreased after surgery, but increased after RAI therapy. The difference in the number of recognized peptides by patients' PBMC before RAI and surgery may reflect the effect of long term therapy with ATD in the patients before RAI vs. the shorter period in patients before surgery. The decreased T cell reactivity to thyroid antigens after thyroidectomy could be the result of removal of a major part of the thyroid gland or redistribution of suppressor-inducer T cells. The increased T cell response after RAI therapy is probably epitope specific, rather than a response to the whole TSHR molecule. Synchronous recognition of peptides 158-176 and 248-263 is important for the development of GD, and the loss of recognition of one of these epitopes may be an early sign of immune remission and a predictor of euthyroidism.

Adult↗